Endometriosis with bilateral endometriomas

Case contributed by Dr Michael P Hartung

Presentation

Pelvic pain.

Patient Data

Age: 35 years
Gender: Female

Bilateral complex adnexal masses. Subtle haziness of the pelvic mesentery/omentum. 

Bilateral complex adnexal masses with fluid-fluid levels and T1 hyperintesity. Several areas of focal T2 hypointensity layering within the cysts - left > right  (indicating chronic blood products). Few smaller faint foci of T1 hyperintensity surrounding the masses. 

Case Discussion

This patient presented with acute abdominal pain in the ED with concern of obstruction or appendicitis. This is a great reminder that active endometriosis can cause abdominal pain, and in this case, the subtle haziness of the mesentery/omentum on CT may reflect blood products or inflammation related to small implants that are not well seen on imaging. Endometriomas were confirmed on MRI, which also showed a few smaller foci of blood products related to smaller implants in the adnexae. 

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